title: Spinal cord injury with a narrow spinal canal: utilizing Torg's ratio method of analyzing cervical spine radiographs.
abstract: A 65-year-old inebriated man crashed his car and presented with spinal shock and neurogenic shock from a cervical spinal cord injury without cervical spine fracture or dislocation. The lateral cervical spine radiography was initially read as normal, except for degenerative disk disease; however, Torg's ratio method of analyzing cervical spinal canal sagittal width indicated the spinal canal was congenitally narrow. Magnetic resonance imaging confirmed this and showed bulging and herniation of multiple invertebral disks between C2 and C7. This case illustrates the value of using Torg's ratio method of analyzing lateral cervical spine radiographs. Although Torg's method has not been prospectively validated, it may be useful to identify patients at risk for cervical spinal cord injuries without fractures or dislocations. An abnormal Torg's ratio may be the only clue to the fact that the patient is at higher risk of spinal cord injury when the patient's history or examination is questionable because of head injury, drug intoxication, or therapeutic sedation and paralysis.
authors.affiliation: Department of Surgery, The University of Arizona College of Medicine, University Medical Center, Tucson, USA.
authors.forename: T
authors.initials: T
authors.lastname: Bey
authors.forename: A
authors.initials: A
authors.lastname: Waer
authors.forename: F G
authors.initials: FG
authors.lastname: Walter
authors.forename: J
authors.initials: J
authors.lastname: Fortune
authors.forename: J
authors.initials: J
authors.lastname: Seeger
authors.forename: K
authors.initials: K
authors.lastname: Fryburg
authors.forename: W
authors.initials: W
authors.lastname: Smith
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D011856:Radiographic Image Enhancement / Q000379:methods*; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology*; D013130:Spinal Stenosis / Q000151:congenital / Q000175:diagnosis*